C.H. v. Community Health Network (mem. dec.) ( 2020 )

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
this Memorandum Decision shall not be FILED
regarded as precedent or cited before any Feb 14 2020, 8:41 am
court except for the purpose of establishing
the defense of res judicata, collateral CLERK
Indiana Supreme Court
Court of Appeals
estoppel, or the law of the case. and Tax Court
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Valerie K. Boots Jenny R. Buchheit
Indianapolis, Indiana Sean T. Dewey
Stephen E. Reynolds
Indianapolis, Indiana
IN THE
COURT OF APPEALS OF INDIANA
C. H., February 14, 2020
Appellant-Petitioner, Court of Appeals Case No.
19A-MH-1891
v. Appeal from the Marion Superior
Court
Community Health Network, The Honorable Melanie Kendrick,
Appellee-Respondent. Magistrate
Trial Court Cause No.
49D08-1907-MH-26523
Riley, Judge.
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STATEMENT OF THE CASE
[1] Appellant-Respondent, C.H., appeals the trial court’s Order, granting Appellee-
Petitioner’s, Community Health Network, Inc. (Community), petition for
temporary involuntary commitment.
[2] We affirm.
ISSUES
[3] C.H. presents this court with two issues on appeal, which we restate as follows:
(1) Whether the trial court made the requisite findings to support the
temporary commitment Order; and
(2) Whether Community presented clear and convincing evidence to sustain
the trial court’s conclusion that C.H. was gravely disabled.
FACTS AND PROCEDURAL HISTORY
[4] C.H. is a thirty-two-year old male who suffers from Schizoaffective Disorder.
He has a history of mental illness and has been treated for mental health issues
by facilities in Indianapolis, Indiana, and Las Vegas, Nevada. He lives in an
apartment in Indianapolis, pays his rent, buys groceries, and cooks for himself.
His income consists of social security disability payments.
[5] On June 25, 2019, C.H. received a court summons related to an alleged credit
card debt. As he believed that the summons constituted harassment, he set fire
to the documents on his front porch and posted a video of the fire to Facebook.
Neighbors alerted the police department. When he heard the police sirens
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approach, C.H. wrote “Cat. Schizo” on his forehead, short for Catatonic
Schizophrenic, and posted a livestream video of himself being taken into police
custody. (Transcript p. 6). The police officers took C.H. to Community, where
he was admitted.
[6] Shortly after admission on June 25, 2019, Community filed an application for
emergency detention and a physician’s statement. C.H. was examined by Syed
Khan, a psychiatrist with Community (Dr. Khan), who later filed a report
following emergency detention and a physician’s statement, asserting that in his
professional opinion, C.H. was suffering from Schizoaffective Disorder, was
dangerous and gravely disabled, and was in need of a temporary commitment
for a period not to exceed ninety days.
[7] On July 12, 2019, the trial court conducted a hearing on the petition. Evidence
was presented that when he first examined C.H., Dr. Khan found C.H. to be
“religiously preoccupied, paranoid, suspicious, guarded, and lacking insight.”
(Tr. p. 21). C.H. was “upset about being on a psychiatric unit. Was unhappy
that lab tests were being ordered and medications were being ordered. [C.H.]
said he would refuse all of that.” (Tr. p. 22). C.H. explained to Dr. Khan that
“he burned the[] papers [on his porch] as an offering to pag[a]n idols and that
he was inhaling the smoke as his way of worshipping god.” (Tr. p. 22). Dr.
Khan examined C.H. on numerous occasions after being admitted and prior to
the hearing, he diagnosed C.H. with Schizoaffective Disorder. As a basis for
his diagnosis, Dr. Khan referred to C.H.’s “multiple [] admissions where he has
presented with both mood episodes as well as psychotic episodes.” (Tr. p. 23).
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As examples of C.H.’s delusional thinking, Dr. Khan mentioned that C.H.
believed that he was “literally slapped by god,” that he has hallucinations about
talking to god, and that he was “operating on special powers.” (Tr. pp. 23-24).
As further support for his diagnosis, Dr. Khan pointed to
[t]he fact that [C.H.] has a very disorganized thought process; his
delusions were extremely circumstantial and extremely
tangential. With responses he derailed often. His responses were
not logical []. He demonstrated that he does have a delusional
belief system. He did indicate that he made some alarming
statements including amputating his own penis, including
statements about murdering the government and murdering
officials, etc. [] He did make statements that he did threaten
family members, threatened to kill them, etc.
(Tr. p. 24). C.H. was offered medication while at Community but refused to
take it. Dr. Khan concluded that C.H. suffered “a substantial impairment or an
obvious deterioration of his judgment, reasoning or behavior that result in his
inability to function independently.” (Tr. p. 25). “Schizoaffective Disorder is a
chronic mental illness that has a life-long course. If untreated it is only likely to
worsen in severity and likely to be more associated with more dangerousness
both to [C.H.] and others. It is a condition that needs to be treated and the
consequences will be great if untreated.” (Tr. p. 25). In his present condition,
Dr. Khan did not believe C.H. could take care of his essential needs. He
clarified that C.H. “has some family support now. And he receives some
government assistance. And if [] this illness continues he would perhaps lose
the family support and maybe even assistance and he is likely to worsen.” (Tr.
p. 26). Dr. Khan clarified that he believed C.H. presented a substantial risk to
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harm himself in light of a prior suicide attempt, a history of not eating, and
starting a fire on his porch. In addition, Dr. Khan noted the threatening
statements C.H. made on Facebook and through other means, in which he
threatened to kill family members and government officials, as well as hurting
himself by dismemberment, “including amputating his own penis.” (Tr. p. 24).
[8] Dr. Khan opined that a temporary commitment was the least restrictive
treatment available and necessary in order to treat C.H.’s mental illness and
improve the quality of his life. His treatment plan included “taking more anti-
psychotic medication, preferably the long acting injectable kind.” (Tr. p. 29).
Once stabilized, C.H. would transition to a community mental health center for
outpatient treatment, medication, and psychotherapy.
[9] C.H.’s brother, P.S., explained that he had concerns about C.H.’s ability to care
for himself, as he has issues taking care of money. P.S. also described C.H.’s
apartment as “very, very, very disheveled . . . it is in bad shape. He was going
to get evicted because of it and we [] straightened up before all of this.” (Tr. pp.
43-44). P.S. confirmed that C.H. had been on medication in the past but had
stopped taking it either in 2015 or 2016. According to P.S., C.H.
does not want to take medication. He wants nothing to do with
it. He finds it being a – like a persecuting him by making him
take it. And I guess the last time when he went in to the hospital
they made him take it.
(Tr. p. 40).
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[10] At the conclusion of the hearing, the trial court granted Community’s request
for a temporary commitment, finding by clear and conclusive evidence that
C.H. is suffering from Schizoaffective Disorder, which is a mental illness, is
gravely disabled, and is in need of custody, care, and treatment at Community
for a period of time not expected to exceed ninety days. The trial court also
granted Community an order to treat unless C.H. did not substantially benefit
from the medications.
[11] C.H. now appeals. Additional facts will be provided as necessary.
DISCUSSION AND DECISION
I. Requisite Findings
[12] As an initial issue, C.H. contends that the trial court failed to make the requisite
statutory finding to sustain a conclusion of grave disability. Specifically, C.H.
asserts that the trial court’s statement at the close of the hearing on
Community’s petition concluding that C.H. “is currently gravely disabled in
that there is some substantial impairment in judgment that affects his ability to
function,” was statutorily insufficient to involuntarily commit him. (Tr. p. 54)
[13] However, even though the trial court paraphrased the statutory definition
during the hearing, the trial court explicitly concluded in its temporary
commitment Order that C.H. “is gravely disabled, as defined in [I.C. §] 12-7-2-
96.” (Appellant’s App. Vol. II, p. 12). As that statute includes the definition of
gravely disabled, as approved by the legislature, C.H.’s argument is without
merit. See, e.g., Heiligenstein v. Matney, 691 N.E.2d 1297, 1301 (Ind. Ct. App.
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1998) (finding trial judge’s remarks were “not necessarily indicative of the legal
standard he will apply” and “[o]nly an examination of a trial judge’s final
decision can clearly reveal which legal standard [actually] was applied to the
evidence.”).
II. Sufficiency of the Evidence
[14] C.H. contends that there was insufficient evidence to support his involuntary
commitment because Community failed to establish that C.H. was gravely
disabled, as defined by statute. 1
[15] “[T]he purpose of civil commitment proceedings is dual: to protect the public
and to ensure the rights of the person whose liberty is at stake.” Civil
Commitment of T.K. v. Dep’t of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 2015).
The liberty interest at stake in a civil commitment proceeding goes beyond a
loss of one’s physical freedom, and given the serious stigma and adverse social
consequences that accompany such physical confinement, a proceeding for an
involuntary civil commitment is subject to due process requirements. Id. To
satisfy the requirements of due process, the facts justifying an involuntary
commitment must be shown by “evidence . . . [which] not only communicates
the relative importance our legal system attaches to a decision ordering an
1
On appeal, C.H. does not challenge the trial court’s finding that he is suffering from a mental illness.
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involuntary commitment, but . . . also has the function of reducing the chance
of inappropriate involuntary commitments.” Id.[16] Indiana law allows an individual to be involuntarily committed if the petitioner
establishes by clear and convincing evidence that “(1) the individual is mentally
ill and either dangerous or gravely disabled; and (2) detention or commitment
of that individual is appropriate.” I.C. § 12-26-2-5(e). Indiana Code section 12-
7-2-96 defines “gravely disabled” as:
A condition in which an individual, as a result of mental illness,
is in danger of coming to harm because the individual:
(1) Is unable to provide for that individual’s food, clothing,
shelter, or other essential human needs; or
(2) Has a substantial impairment or an obvious deterioration of
that individual’s judgment, reasoning, or behavior that results
in the individual’s inability to function independently.
[17] It is not necessary to prove both prongs to establish grave disability. W.S. v.
Eskenazi Health, Midtown Cmty. Mental Health, 23 N.E.3d 29, 34 (Ind. Ct. App.
2014), trans. denied. In reviewing the sufficiency of the evidence supporting an
involuntary civil commitment, we consider the probative evidence and
reasonable inferences supporting the order, without reweighing the evidence or
assessing witness credibility. Civil Commitment of J.B. v. Cmty. Hosp. N., 88
N.E.3d 792, 795 (Ind. Ct. App. 2017). We will affirm if a reasonable trier of
fact could find the necessary elements proven by clear and convincing evidence.
Id. Clear and convincing evidence requires the existence of a fact to be highly
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probable. Id. There is no constitutional basis for confining a mentally ill person
who is not dangerous and can live safely in freedom. Commitment of J.B. v.
Midtown Mental Health Ctr., 581 N.E.2d 448, 451 (Ind. Ct. App. 1991), trans.
denied.
[18] Focusing on an implicit temporal element included in the gravely disabled
prong, C.H. references Dr. Khan’s testimony that speaks of future
contingencies. Specifically, during the hearing, Dr. Khan noted that although
C.H. currently has family support and receives government assistance, that
might change “if this illness continues” and he “would perhaps lose the family
support and maybe even assistance.” (Tr. p. 25). He contends that “Dr.
Khan’s testimony implicitly acknowledged that C.H. was currently taking care
of all his essential needs when he speculated” about possible future scenarios.
(Appellant’s Br. p. 14).
[19] In B.J. v. Eskenazi Hospital/Midtown CMHC, 67 N.E.3d 1034, 1040 (Ind. Ct.
App. 2016), we reversed the trial court’s order of involuntary regular
commitment where the treating psychiatrist—who was the only witness to
testify with regards to B.J.’s grave disability—“evaluated B.J.’s hypothetical
state based on future contingencies” that could occur if B.J. did not have his
parents’ support, or if B.J. did not adhere to treatment. We noted that apart
from the doctor’s testimony, the only evidence to support the commitment were
threats that B.J. made to other individuals, his missed appointments, and his
behavior at the hearing—which we determined to be insufficient. Id. The court
noted that:
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We are not holding that evidence of threats may never be
sufficient evidence of a grave disability, but there was no
evidence that B.J. destroyed property or put himself or others in
actual danger after he began his treatment.
Id.[20] Similarly, in T.K., 27 N.E.3d at 276-77, T.K. was employed, rented his own
home, owned two vehicles, and otherwise “was not at risk of suffering a lack of
food, clothing or shelter.” T.K. denied he had a mental illness, refused
treatment, and had threatened others verbally. Id. at 277. The petitioner’s
expert witness testified that he “personally did not believe that [T.K.] would be
a danger to self or others[.]” Id. at 276. Our supreme court found that “at best,
the evidence suggests that T.K.’s loud, boisterous, and rude public behavior
harmed his reputation and made others not want to be around him.” Id. “T.K.
made no physical outbursts, destroyed no property, did not put himself or
others in actual danger with idiosyncratic behavior, and was not at risk of
suffering a lack of food, clothing, or shelter.” Id. Our supreme court concluded
that there was not sufficient evidence to support a civil commitment on grounds
of grave disability. Id.
[21] We find B.J. and T.K. to be inapposite to the situation at hand. Unlike both
B.J. and T.K., C.H.’s most recent admission to Community was prompted by
C.H.’s destruction of property, setting fire to legal papers on his front porch,
and writing “Cat Schizo” on his forehead while live streaming his arrest on
Facebook. (Tr. p. 6). Dr. Khan described C.H.’s behavior upon admission as
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“religiously preoccupied, paranoid, suspicious, guarded and lacking insight”
when they first met. (Tr. p. 21). C.H. told him that “he burned the [] papers as
an offering to pag[a]n idols and that he was inhaling the smoke as his way of
worshipping god.” (Tr. p. 22). This behavior continued to be displayed during
the hearing of Community’s petition in which C.H. made frequent reference to
biblical verses and displayed incoherent thinking.
[22] During the course of his hospital stay, C.H. displayed mood episodes and
delusional thinking, both of which supported his diagnosis of Schizoaffective
Disorder. Dr. Khan mentioned that C.H. believed that he was “literally
slapped by god,” that he had hallucinations about talking to god, and that he
was “operating on special powers.” (Tr. pp. 23-24). C.H. denied having a
mental illness and refused all medication. While a denial of mental illness and
refusal to medicate alone cannot support a finding of grave disability, these
factors may be included in our analysis. See, e.g., Golub v. Giles, 814 N.E.2d
1034, 1039 (Ind. Ct. App. 2004) (patient’s refusal to accept his mental illness
and cooperate with his treatment, paired with his history of mental health issues
and destructive behavior, was sufficient to support a finding of grave disability).
[23] Evidence was presented that due to his mental illness, C.H. is unemployed.
P.S., C.H.’s brother, testified that without treatment, C.H. would lose his
family’s support, explaining that C.H.’s family members “are at [their] wits
end.” (Tr. p. 41). Although they “want the best for [C.H.],” “everybody in
[the] family is at the point where they cannot deal with it anymore.” (Tr. p.
41). P.S. described that C.H. had planned to move back to Las Vegas earlier in
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the year to live with his mother, but their mother asked P.S. to ensure that C.H.
would not do so “because of how he was acting over the internet again.” (Tr.
p. 37). P.S. admitted that he “[o]ne hundred percent long term” had concerns
about C.H.’s ability to care for himself. (Tr. p. 37). P.S. referenced C.H.’s
gambling problems in the past and described C.H.’s apartment as “very, very,
very disheveled[.]” (Tr. p. 43).
[24] C.H. admitted to making threatening statements to his family members and on
social media. While C.H. characterized his social media posts as “art,” Dr.
Khan testified that these threats were “likely to bring upon some harm to
himself and possibly to others.” (Tr. p. 27). “He has threatened to kill family
members, his brother, his sister, [and] other family members. He has made
public posts on social medial about wanting to murder people, etc.” (Tr. p. 27).
[25] Viewing the totality of the evidence, the trial court received evidence from
multiple people, including C.H., that C.H. was unable to function
independently by himself and that there was a substantial impairment of his
judgment. Physical and testimonial evidence was presented of C.H.’s threats to
harm himself and others. Accordingly, the trial court could find by clear and
convincing evidence that C.H. was gravely disabled. We affirm the trial court’s
Order to temporarily commit C.H.
CONCLUSION
[26] Based on the foregoing, we conclude that the trial court made the requisite
findings to support the temporary commitment Order; and Community
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presented sufficient evidence to sustain the trial court’s conclusion that C.H.
was gravely disabled.
[27] Affirmed.
[28] Baker, J. and Brown, J. concur
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